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HomeMy WebLinkAboutBuilding Permit #316 - 148 WAVERLY ROAD 10/20/2006 TOWN OF NORTH ANDOVER NpRT1� APPLICATION FOR PLAN EXAMINATION h o `f' # Permit NO: Date Received N , Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION-(` OW RVeY 1 In CU �- �l��© ire r M 1 C-t�,JJ Print PROPERTY OWNER C✓l 6c y 0,CD VA M /[ �f czdc(f Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family Addition XFwo or more family ❑ Industrial Ej Alteration No. of units: KRepair, replacement ❑ Assessory Bldg ❑ Commercial Demolition Moving(relocation) ❑ Other• ❑ Others: Foundation only DESCRIPTION\ OF WORK TO BE PREFORMED TW n i T(� C' r� �C'tn oVAt«�vt Identification Please Type or Print Clearly) OWNER: Name: ,t 1,e,rc,nY\ M Y L7 Phone: Address: 1-5--o t,tJ o VP_du 1Zd �• r odQ r �1 �` J 1 CONTRACTOR Name: Phone: ,`address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: :address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOT,4L ESTIMATED COST BASED ON$125.00 PER S.F. Total Project CosstgS 3-000 + R-000 = /F,Dov FEE:$ Check No.: o"�l Receipt No.: 1 j Page lof4 f TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer �i Tobacco Sales Food Packaging/Sales ❑ Well '� Permanent Dumpster on Site Cli Private(septic tank, etc. ❑ Electric Meter location to I project NOTE: Persons contracting w'lr unregistered contractors do not have access to the guarantyfund Signature of Agent/Ow,_ Signature of contractor Plans Submitted ❑ dans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ i 1 COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HFALTH ❑ ❑ C1 MMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: "Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Signature& Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension ' Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use P r i 7777— Doc INSPE750NAL SERVICES DEPARTMENT:1311Fi)RM05 (Plated)A1C.)an_'006 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed p d Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPE('TIONAI.SERVICES DEPAR'rMEN'rMFORA105 Paige 4 of a f. Location I SL) No. Date / -22-0 ,f .t. TOWN OF NORTH ANDOVER o 9 Certificate of Occupancy $ sAC NUS t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 971 3r U Building Inspector NORTIy 0"_ Of t R over ltoo No. � - �` Z dover, Mass., T — LAKE �1 co V 7,9504ATED PPS �y BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System V� ` � h �� BUILDING INSPECTOR THIS CERTIFIES THAT......��s...... ....................................................r..le.4i�AW4.. ............................................ Foundation has permission to erect........................................ buildings on 115"b W............. . ..% . . .... .....f .................. Rough to be occupied as .......�►.t. ... ......X&/..qtr.. ......................... . . .. . . . .. . . ................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final Z PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU Rough . ..... ... . .. .. .......... ............ . Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. +,Hrii TOWN OF NORTH ANDOVER OFFICE OF 'w 1 BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-64 ., North Andover, Massachusetts 01845 +cr+U5 Gerald X. Brown Inspector of Buildings Telephone(978)688-9545 Fax (978)688-9542 H0%IEOWNER L[CENSE EXEMPTION Please print DATE:_Iqo JOB LOCATION: ( to W ,lumber Strce dress tiiap/Lot HOMEOWNER . Name Home Phone s Work Phone PRESENT MAILING ADDRESS �(3 W Q\j N` V DV V City Town State I Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two Family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The.undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned"homeowner"certifies that he,'she understands the Town of North Andover Building Department minimum inspection procedures and r5eements a d that he/she will comply with said procedures and requirements. APPROVAL OF RUILDING OFFICIAL I, rm Hnnr�wn��r;F.�,�uil�iir.n ;. IFI)GF.1P10 Fc iH